NHS v ministers: A case of deja vu?

Conflict and resolution puzzle pieces Image copyright Thinkstock

The timing is uncanny. Some 67 days after the 2010 election the then health secretary, Andrew Lansley, unveiled a set of plans that came to define the approach of David Cameron's first government to health.

His reforms set in train a series of events that led to the government in England being pitted against the medical establishment. The policy had to be paused (and redrafted) and at one point even looked like it was on the brink of collapse altogether.

The changes - dubbed so big you could see them from space by the NHS England chief executive Sir David Nicholson - were eventually implemented but then used as a stick with which to beat the government. Critics argued that valuable time was wasted when the health service was under incredible pressure.

The current health secretary, Jeremy Hunt, took slightly longer to light the fuse. It was 16 July this year - 70 days after polling - that Mr Hunt took to the stand at a London conference venue to deliver a hard-hitting speech about his plan for seven-day care in the NHS. But is it possible the effect could be the same?

In that speech and the media interviews to accompany it, he accused the British Medical Association of being a "roadblock" to reform and insinuated a "Monday to Friday" culture was killing patients.

'Unjustifiably frightening'

Consultants were given a deadline of September to return to the negotiating table - or face the contract paving the way for more weekend working being imposed on them.

His tough stance prompted an angry Twitter campaign. But as the summer turned to autumn, Mr Hunt took the fight to the junior doctors. Talks on their new contract had actually broken down in 2014 but the health secretary upped the pressure linking the dispute to the seven-day drive and saying he could not negotiate on a manifesto commitment.

The BMA has refused to budge, doctors have taken to the streets and junior doctors are now being balloted over industrial action, while normally apolitical royal colleges have started expressing concerns.

What is junior doctors row about?

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This week Royal College of Paediatrics and Child Health president Prof Neena Modi accused Mr Hunt of using "unjustifiably frightening" language and criticised his intention to impose the contract on them - arguing they need to be "valued and respected".

Other colleges have also waded in - although in a more measured way. This is starting to mirror what happened when the controversy over the Lansley reforms reached its peak in the first half of 2011.

Of course, there are some differences. The criticism of Mr Hunt has been largely confined to those within the health service and focussed on his handling of the issue rather than the detail of what he has been trying to achieve. Indeed, the Tories remain convinced that their seven-day policy is popular among the public - and on the surface it is certainly easier to understand.

But a lot could change in the coming months. Industrial action seems inevitable. It would be a major surprise if, when the results of the ballot are released next Thursday, the vote isn't an overwhelming yes in favour of it.

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There will then be pressure on Mr Hunt to make concessions. If that doesn't happen, junior doctors would be walking out just as winter - and the extra pressures that brings for the health service - is getting into full swing.

But with deficits already rising, waiting times being missed and staff shortages getting worse, could people start questioning whether the need for improved seven-day care is necessary in such a tricky climate? There are certainly those within the profession and respected experts on the outside who do question it. Their voices could well start to come to the fore.

Of course, public opinion could turn against the doctors instead of the politicians. But it would be a brave member of government to bet on that (polling consistently shows medics are trusted more and the BMA is widely seen as a formidable opponent in these situations).

At this stage no-one can be sure which way this will go. The stakes couldn't be higher.

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